Public health messages about preventing suicides involving firearms are more likely to be successful if they acknowledge the values and beliefs of gun owners, suggests a new study. Gun owners who held more conservative political beliefs, more strongly supported gun rights and lived in rural areas were much more likely to consider temporarily restricting firearm access from someone at high risk for suicide if a public health message emphasized the importance of the Second Amendment and being a responsible gun owner.

“Guns are a flashpoint of cultural identity in America, so if your doctor or a public health message is talking about taking away your guns, some people feel threatened and stop listening,” said lead author Elizabeth Marino, an assistant professor of anthropology at Oregon State University, Cascades. “But protecting people from suicide and from accessing guns when they are thinking about suicide is really important. We need to find a way—and it will probably come from the gun-owning community—to talk about how to keep people safe without triggering identity politics.”

Of the 42,773 deaths by suicide in 2014, half involved firearms. Because firearms are so lethal, only 10% of people who use them in a suicide attempt survive, compared to much lower rates for other methods. Further, multiple studies have shown that presence of a firearms in the home increases the risk of suicide among household members.

The researchers compared gun owners’ receptiveness to four different suicide prevention messages that involved restricting gun access when a friend, family member or oneself is at increased risk of suicide.

The control message simply included the statement: “Mental health and suicide prevention are important public health issues.” The standard prevention message included “information on suicide warning signs and how to take action to prevent suicide from the National Suicide Prevention Lifeline’s information sheet and wallet card.” Then the researchers developed a “gun culture” message that recommended restricting a person’s access to firearms while still “respecting the cultural values and rights of gun owners.” The fourth message included the standard wording plus the gun culture message.

To develop the gun culture message, the researchers first conducted focus groups and interviews with 22 male and 17 female gun owners who live in central Oregon rural communities.

“We started with the assumption that rural gun-owning communities knew something about keeping people safe from gun violence,” Marino said. “The public health message we developed was in line with their understanding of guns and gun violence, which is quite nuanced and savvy.”

Shutterstock

The interviews lasted 1-2 hours and “were designed to understand the culture of gun ownership, especially in rural environments, including acceptable, non-threatening methods of improving gun safety that respect the rights of gun owners while keeping suicidal patients safe,” the researchers wrote. Questions related to general firearm use and safety, communicating about firearm safety and communicating with healthcare providers about firearms.

The message the researchers developed as a result of these interviews “emphasized the importance of protecting Second Amendment rights at the same time as protecting oneself and one’s friends and family members from unnecessary harm.” Recommendations included storing someone else’s firearms temporarily or giving yours to another person during an at-risk or crisis period. The researchers framed these recommendations as an aspect of “being a proud, responsible and safe gun owner” and noted that restricting access to firearms when suicide risk is heightened can be especially effective even if the people at risk consider looking for other ways to die by suicide.

The researchers tested these four messages with 817 gun owners who viewed one of the four and then answered a 10-15 minute survey online through Amazon Mechanical Turk. The first set of questions asked about the respondent’s political beliefs (based on eight different issues) and gun rights attitudes.

Then, after the respondent viewed the suicide prevention message, the survey asked how likely, on a scale of 1 to 7 (with 7 being “extremely likely”), the respondent would be to take either of two actions if a family member or a friend showed suicide warning signs: “remove guns from their home temporarily” and “ask them to give away their guns temporarily to you or another trusted individual.”

The survey also asked whether the respondent, if thinking about suicide, would “speak with a friend or other trusted individual about temporarily giving them your guns,” “speak with your doctor about temporarily giving your guns to someone else,” and “give your guns temporarily to a friend or trusted individual.” The last questions asked about respondents’ likely responses if they were feeling suicidal, had talked to their doctor about depression or suicidal thoughts, and the doctor asked about their guns. The questions asked how likely the person would be to “tell your doctor that you own guns,” “tell your doctor how many guns you own,” and “tell your doctor where you keep your guns.”

Of the four conditions, those who read the one with the standard and gun culture messages were most likely to restrict access to firearms and talk to their doctor about them. Those exposed to the control and the standard messages had an equal likelihood of doing so. The gun culture message was close to the standard-plus-gun culture message but only marginally better than the control and standard messages alone.

For example, those who viewed the control and standard messages averaged 5.38 and 5.45, respectively, on a scale of 1 to 7 for their likelihood to restrict firearm access from a family member at risk for suicide. The gun culture messaging resulted in an average of 5.93, and the standard-plus-gun culture message had an average of 6.07.

Similarly, average willingness to restrict access from a friend was 5.46 and 5.51 after control and standard messages but 5.94 after the standard-plus-gun culture message. Scores were lower across the board for willingness to restrict guns for oneself: 4.57 and 4.51 for the control and standard conditions, and 5.19 for the standard-plus-gun culture condition. Respondents’ willingness to talk to their doctor had the lowest scores: 3.95 and 4.19 for control and standard messages, and 4.84 for the standard-plus-gun culture message.

When the researchers then analyzed answers with regards to respondents’ political orientation, gun rights attitudes and rural status, they found that the four conditions made little difference to answers from more liberal or urban respondents or those with weaker support for gun rights.

However, “the more a person identified with being conservative, or identified with gun owning and gun rights culture, or lived in a rural area, the more that person felt that the message was worthy of listening to and taking seriously,” Marino said. These individuals’ willingness was an average 1.2 points higher if they read the standard-plus-gun culture message, compared to the standard and control messages.

The authors note that public health messages can never be “culture neutral,” which Avery Holton, a professor of communication at the University of Utah in Salt Lake City, agreed with. Holton focuses on media messages related to health and their impact on the public.

“We can attempt to achieve neutrality on a number of levels, but we almost always have a form of existing or developed bias,” Holton said. “Each of our cultural backgrounds drives how we see the world and act within it. Thusly, media messages or other messages cannot be culturally neutral because they are filtered through the cultures of individuals.” This is especially true with a polarizing issue such as firearms since political and religious beliefs, and media exposure, can affect individuals’ beliefs about gun safety, he said.

A strength of the study, Holton said, was its focus on rural populations’ attitudes since suicide rates are higher in rural areas. The study is an interesting, important step in tailoring public health messages to be more effective, he said, because the authors are exploring “how particular cultural cues can be used for particular audiences to potentially reduce suicide or, at the very least, access to guns during times of suicidal thought.”

Holton noted that research over the past decade has revealed how much more relatable narratives are than summaries of facts.

“In other words, we tend to understand information better when it's provided through a story we can relate to,” he said. “Relatability can play a big role when trying to help people understand, process and positively act on health information.”

The researchers also looked at whether age, gender, race/ethnicity, household income, education or military status played a role in willingness to restrict firearms during crisis periods. Only gender appeared to influence answers, with women being more likely to temporarily restrict firearms for a friend, family member or themselves. Yet the suicide rate among men is about four times higher than among women.

The increased willingness to consider temporarily restricting access to guns among rural gun owners in the study likely resulted in part from the fact that the researchers relied on rural gun owners’ interviews to develop the messaging. They noted that future research would require using data collected from the targeted group to develop appropriate, potentially effective messaging.

“There is robust knowledge and wisdom about solutions to gun violence which exists within communities that have high levels of gun ownership and gun violence,” Marino said. “Our findings firmly assert that the solutions to gun violence in America might be best explored by linking scientific investigations with community knowledge.”

The study only measured people’s intentions regarding restricting firearm access, not their actual behaviors, which would require additional research. The authors also noted that future study should investigate other behaviors the respondents show since those who already follow stricter gun safety behaviors in the home may be more willing to temporarily restrict their own access or someone else’s to firearms.

The authors also noted that their findings may not necessarily be extended to all demographic groups in all areas since 82% of survey respondents were white. Respondents were more diverse in terms of age, household income and gender (54% male, 46% female). However, most (78%) lived in urban areas of at least 250,000 population, and 90% had at least some college. People whose highest level of education is a high school diploma are at higher risk for suicide than those with some college.

Marino suggested that any gun-owning demographic or community likely already has a code of values related to gun safety practices. Researchers and public health officials can tap into these to design more effective messaging.

“To solve complex problems we need to first find common ground. Suicide is killing Americans at a higher rate than murder or war,” Marino said. “We may, as a country, think about guns differently from one another, and still think about suicide in similar, compassionate and empathetic ways. From this empathy emerge solutions.”

I am a freelance science and multimedia journalist who specializes in reporting on vaccines, pediatric and maternal health, parenting, public health, mental health, medical research, and the social sciences. My work has appeared in The New York Times, NPR, Scientific America...